Liver 4

Question 1

Most common clinical presenting sign in Budd Chiari syndrome?

Answer 1

ascites

abdomen gets distended with ascitic fluid

Question 2

Most frequent causes of Budd Chiari Syndrome?

Answer 2

myeloprolifertive disorders like polycythemia vera

Question 3

Most common benign liver tumors?

Answer 3

hemangiomas

more common in women

Question 4

Kassabach-Merrit syndrome?

Answer 4

thrombocytopenia
consumptive coagulopathy
assc w/ hemangiomas

Question 5

When do we resect hemangiomas?

Answer 5

when assc/ w Kassabach-Merrit syndrome; change in size; rupture

Question 6

What liver lesion is this?

Answer 6

vividly enhances on arterial phase
rapid washout

elevated alpha fetoprotein

Question 7

These lesions found in women 20-40 yrs age who take OCP;

Answer 7

adenomas

Question 8

Whats the concern with adenomas?

Answer 8

risk of rupture

risk of malignant degeneration esp if > 5 cm in size

Question 9

2nd most common benign liver tumor?

Answer 9

FNH

Question 10

How does FNH present on CT imaging?

Answer 10

peripheral arterial enhancement

central stellate scar

Question 11

What liver lesion has a central stellate scar?

Answer 11

FNH

Question 12

This liver lesion shows peripheral nodular enhancement on arterial phase with progressive centripetal fill in portal venous phase:

Answer 12

hemangioma

Question 13

Hydatid cysts caused by?

Answer 13

echinococcus granulosus

Question 14

These cysts tend to have daughter cysts, with calcifications;

Answer 14

hydatid cysts

Question 15

What do we worry about with hydatid cysts caused by echincocus?

Answer 15

rupture– >anaphylaxis

Question 16

Tx for hydatid cysts?

Answer 16

antihelminthics pre and post op recommended

injection of alcohol or hypertonic saline–> kill scoloceles

Question 17

Most common complication of percutaneous liver bx?

Answer 17

intraperitoneal hemorrhage

Question 18

Bile leak occurs in 10% of pts after hepatectomy; how is it defined?

Answer 18

bilirubin is >3x normal bilirubin at around day 3

percutaneous drainage usually treats it

Question 19

What’s the criteria for orthotopic liver transplant?

Answer 19

pts w/single lesion 2-5 cm in diameter + 2-3 tumors less than 3 cm each

without evidence of macro-vascular invasion or extra-hepatic disease

Question 20

Absolute contraindications for liver bx?

Answer 20

pt inability to cooperate with procedure

can’t identify an adequate biopsy site

Question 21

This refers to constellation of signs and symptoms related to obstruction of hepatic veins:

Answer 21

Budd Chiari syndrome

Question 22

Diagnosis of BC syndrome?

Answer 22

duplex US

confirmed by angiography of hepatic veins and IVC

Question 23

At what size cut off do hepatic adenomas need to be removed because of concern for malignant transformation and rupture?

Answer 23

5cm

Question 24

Tx of choice for amebic liver abscesses?

Answer 24

metronidazole 500-750 mg 3x/day for 7-10 days

90% cure rate

Question 25

Why is metronidazole effective for amebic liver abscesse

Answer 25

reaches high concentrations in the liver/intestines

Question 26

How does hemangioma appear on US?

Answer 26

defined compressible mass

Question 27

What’s FOLFOX?

Answer 27

5-FU

oxaliplatan